Chapter 15: Using therapeutic modalities

True or false: The ratio of heat exchange in conduction is independent of exposure time

False

True or false: electrical stimulating units have a constant waveform regardless of the capability of the generator

False A waveform is a graphic representation of the shape, direction, amplitude, and direction of a particular electrical current. Electrical stimulating units can take on various waveforms depending on the capability of the generator. Biphasic, monophasic, and pulsatile units can produce currents with waveforms that are sine, rectangular, square, or spiked in shape

_________ creates a therapeutic environment with dry heat and forced convection through a suspended airstream. Fluidotherapy A hydrocollator pack Whirlpool therapy A paraffin bath

Fluidotherapy Fluidotherapy creates a therapeutic environment with dry heat and forced convection through a suspended airstream.

Identify a true statement about the physiological effects of heat Too little heat is capable of damaging tissue. Heat should be absorbed into a tissue and spread to the adjacent tissue for an effective response. Every tissue reacts the same way to heat. The body's response to heat is independent of the type of heat energy applied..

Heat should be absorbed into a tissue and spread to the adjacent tissue for an effective response. The body's response to heat depends on the type of heat energy applied, the intensity of the heat energy, the duration of application, and the unique tissue response to heat. For a physiological response to occur, heat must be absorbed into the tissue and spread to adjacent tissue. To effect a therapeutic change that results in normal function of the absorbing tissue, the correct amount of heat must be applied. With too little, no change occurs; with too much, the tissue may be damaged.

Electrode setup

In electrotherapy, electrode pads are affixed directly to the skin. Electrodes are of different sizes. Using a large (dispersive) electrode remote from the treatment area while placing a smaller (active) electrode as close as possible to the nerve or muscle motor point will give the greatest effect at the small electrode. The large electrode disperses the current over a large area; the small electrode concentrates the current in the area of the motor point. The physiological effects can occur anywhere between the two pads, but they usually occur at the active electrode because current density (the amount of current in a given area) is greater at this point. Many newer electrical stimulating units have pads that are of equal size; thus, both electrodes are considered active electrodes.

Which of the following is true of pulsed ultrasound waves? It produces ultrasound energy 100% of the time and there is no off period. Its output remains constant throughout the treatment. Its output is periodically interrupted and no ultrasound energy is produced during the off period. It is most commonly used to produce thermal effects.

Its output is periodically interrupted and no ultrasound energy is produced during the off period. The percentage of time that ultrasound is being generated is referred to as the duty cycle

Which of the following massage strokes involves kneading and heavy tissues such as the trapezius? Tapotement Vibration Petrissage Friction

Petrissage

Which of the following terms refers to the decrease in intensity as sound enters deeper tissues? Airflow resistance Attenuation Decay rate Impedance

Attenuation

In muscle strengthening, intensity should be increased at a frequency of ____________. 80 to 100 pulses per second 50 to 60 pulses per second 20 to 40 pulses per second 20 to 30 pulses per second

50 to 60 pulses per second Intensity should be increased at a frequency of 50 to 60 pps to elicit a tetanic muscle contraction using surging current set at 15 seconds on and 50 seconds off. Treatment should include 10 repetitions three times per week. For best results, the patient should combine this electrically induced tetanic contraction with maximal active contraction against some resistance

In which of the following therapeutic methods does a trainer use charts to learn about the relationship between specific points and the area of pain? Deep transverse friction massage Massage Acupuncture Ultrasound

Acupuncture

Irwin, a long jumper, sprains his leg after a faulty take off. His physical trainer suggest cryotherapy to provide relief for his injury. Identify a technique that can be used to treat Irwin's sprain. Applying an ice pack on Irwin's legs Giving a massage on Irwins legs Taking Irwin for a paraffin bath Immersing Irwin's legs in a lowboy tank

Applying an ice pack on Irwins legs

Which of the following terms refers to the transference of heat through the movement of fluids or gases? Conversion Conduction Radiation Convection

Convection - refers to the transference of heat through the movement of fluids or gases. Factors that influence convection heating are temperature, speed of movement, and the conductivity of the part. The best example of modalities that use convection is hot and cold whirlpools.

_______ is a technique that combines cyrotherapy, or the application of cold, with exercise.

Cryokinetics is a technique that combines cryotherapy, or the application of cold, with exercise.The goal of cryokinetics is to numb the injured part to point of analgesia and then work toward achieving normal range of motion through progressive active exercise.

Types of tapotement and their features

Cupping - it is a series of percussion movements rapidly performed at a constant tempo. Hacking - most appropriate for treating heavy muscle area. pinching - least percussive of all movements

Current intensity refers to the _________. Ability of an electrical stimulating unit to change its magnitude. Number of waveforms being emitted by an electrical stimulating unit voltage output of the stimulating unit Length of time that current is flowing

Current intensity is the voltage output of the stimulating unit

Leo, a biker, sustains a ligament tear during a race. His physical trainer recommends ultrasound therapy for effective rehabilitation. The procedure involves the use of mineral oils in water-soluble gels as coupling medium to facilitate transmission of ultrasound into the tissues and to provide airtight contact with the skin. Which of the following application techniques is used to treat Leo's injury? Underwater application Gel pad technique Moving the transducer Direct skin application

Direct skin application (Coupling medium)

Which of the following is a desirable therapeutic effect of heat? (Check all that apply) Increasing exudation in the postacute phase of healing Increasing the extensibility of collagen tissues Increasing joint stiffness Increasing blood flow

Increasing the extensibility of collagen tissues Increasing blood flow The desirable therapeutic effects of heat include increasing the extensibility of collagen tissues; decreasing joint stiffness; reducing pain; relieving muscle spasm; reducing inflammation, edema, and exudates in the postacute phase of healing; and increasing blood flow

Which of the following makes use of two separate electrical generators that emit currents at two slightly different frequencies? Interferential currents low-intensity stimulators Iontophoresis shortwave diathermy

Interferential currents make use of two separate electrical generators that emit currents at two slightly different frequencies. Two pairs of electrodes are arranged in a square pattern such that the currents cross one another, creating an interference pattern at a central point of stimulation. The interference pattern creates a larger area of stimulation

___________ _____________ is a mechanical injury modality that makes use of nylon pneumatic inflatable sleeve applied around an injured extremity.

Intermittent compression

Phonophoresis is predominately used to _______. Treat bursitis and muscle strains Heal nonunion fractures and ligaments Introduce hydrocortisone and anesthetic into tissues Reduce joint pain swelling in neuritis.

Introduce hydrocortisone and an anesthetic into the tissues Phonophoresis is a method of transporting medications through the skin using mechanical vibrations produced by an ultrasound generator

Which of the following techniques uses electrical energy? Iontophoreis Intermittent compression Ultraviolet light therapy Microwave diathermy

Iontophoresis The electrical stimulating current and iontophoresis use electrical energy

___________ is the therapeutic technique in which electrically charged particles are introduced into the body tissues by means of direct current.

Iontophoresis is a therapeutic technique that involves the introduction of ions into the body tissues by means of a direct electrical current

How is deep stroking method different from light stroking? It brings about definite physiological responses. It discourages venous drainage. It is used when an area is too sensitive to touch. It induces relaxation.

It brings about definite physiological responses. Effleurage, or stroking, is divided into light and deep methods. Light stroking is designed primarily to be sedative and used in the early stages of injury treatment. Deep stroking is a therapeutic compression of soft tissue, which encourages venous and lymphatic drainage. Light stroking can induce relaxation and deep massage is designed to bring about definite physiological responses

Identify a true statement about a shortwave diathermy unit. It has a power amplifier that converts biphasic current to monophasic current. It lacks a frequency generator. It has a power oscillator that converts low amplitude waves to high amplitude waves. It lacks a circuit design that tunes in a patient automatically or manually

It has a power amplifier that convert biphasic current to monophasic current. It has an oscillator that produces high frequency and a power amplifier that converts biphasic current to monophasic current

Identify a true statement about therapeutic ultrasound. It creates an interference pattern at a central point of stimulation. It is a deep-heating modality and is used primarily for elevating tissue temperatures. It uses a power amplifier and a frequency generator. It emits electromagnetic energy that is capable of producing temperature increases.

It is a deep-heating modality and is used primarily for elevating tissue temperatures.

Which of the following is specifically treated by deep transverse friction massage? (Check all that apply) Heavy tissue areas Joint capsules Tendons Trapeziums

Joint capsules Tendons The transverse, or Cyriax, method of deep friction massage as a specific technique for treating muscles, tendons, ligaments, and joint capsules.

The friction massage is used often around the ________. Latissimus dorsi Joints Triceps Trapeziums

Joints The friction massage is used often around joints and other areas where tissue is thin and on tissues that are especially unyielding, such as scars, adhesions, muscle spasms, and fascia.

For an energy output to be uniform, the beam nonuniformly ratio must be ___________. Low Constant High Zero

Low The amount of variability of intensity in the beam is indicated by the beam nonuniformity ratio (BNR). The lower the BNR, the more uniform the energy output. Optimally, the BNR would be 1:1.

Identify a scenario that best describes the use of whirlpool bath. Ronald accidentally drops a dumbbell over his feet and undergoes treatment by immersing the injured area in a paraffin mixture. Martha, a ballet dancer, sustains muscle spasm and undergoes a therapy that is a combination of massage and water immersion. Steve suffers from ischemia and receives thermotherapy through the application of silicate gel in a cotton pad Mason sustains a sprain during his football game and uses ice massage to relieve his pain

Martha, a ballet dancer, sustains muscle spasm and undergoes a therapy that is a combination of massage and water immersion. Whirlpool medium assists the body part by reducing swelling, muscle spasm, and pain. Because of the buoyancy of the water, active movement of the part is also assisted

Which of the following therapeutic modalities involves the usage of movements such as gliding, compressing, stretching, and percussing? Low-level laser therapy Iontophoresis Massage Cyrotherapy

Massage Massage is the systematic manipulation of the soft tissues of the body. The movements of gliding, compressing, stretching, percussing, and vibrating are regulated to produce specific responses in the patient

__________ current is otherwise called direct current.

Monophasic Current (DC) also called direct current, flows in one direction only from the positive pole to the negative pole. DC may be used for pain modulation or muscle contraction or to produce ion movement. Specific physiological effects are determined by how the treatment parameters are set on the stimulating unit. Most electrical stimulators currently used in athletic training settings are monophasic units which deliver pulsed high-voltage currents.

Which type of contraction is used to stimulate circulation by providing fluid and blood through the venous and lymphatic channels back to the heart? Opiate pain control Retardation of atrophy Muscle pumping Muscle strengthening

Muscle pumping This type of contraction is used to help stimulate circulation by pumping fluid and blood through the venous and lymphatic channels back to the heart.

Electrical Units

Ohms - it is the measurement of resistance to the passing of an electrical current along a conductor watts - measurement of electrical power voltage - the force that moves along the current along the conductor

Which of the following refers to the production of electric current by applying pressure to certain synthetic crystals? Diffraction Attenuation Artificial reverberation Piezoelectric effect

Piezoelectric effect

Identify a special consideration associated with therapeutic ultrasound. reproductive organs can be exposed to ultrasound. Epiphyseal areas in children should have the maximum exposure to ultrasound. Thermal ultrasound is an excellent treatment for acute injuries. Pregnant women should not receive ultrasound.

Pregnant women should not receive ultrasound. Reproductive organs and women who are pregnant must not receive ultrasound.

Which of the following scenarios best describes ultrasound application that involves moving the traducer? Kenny's physician treats his wrist injury using soundwaves underwater. Lissa, a physician, transmits ultrasound energy to a treatment area through a series of pads coated with gel. Sam's physician uses an ultrasound therapy that leads to an even distribution of energy and reduced hot spots. Monica's physical trainer uses a coupling medium to streamline the transmission of ultrasound waves to the skin.

Sam's physician uses an ultrasound therapy that leads to an even distribution of energy and reduced hot spots.

Which of the following therapeutic modality techniques relies on radiation for the transfer of heat energy? Ultrasound therapy Cyrotherapy Intermittent compression Shortwave diathermy

Shortwave diathermy Radiation is the process whereby heat energy is transferred from one object through space to another object. Shortwave diathermy relies on the process of radiation for energy transfer.

The energy produced in a __________ is capable of producing temperature increases in the deeper tissues. Shortwave diathermy Intermittent compression Low-intensity stimulators Phonophoresis

Shortwave diathermy Shortwave diathermy immense electromagnetic energy that is capable of producing temperature increases in the deeper tissues

Identify the forms of energy that are most appropriate and relevant to the use of therapeutic modalities.

The forms of energy that are relevant to the use of therapeutic modalities are: thermal conductive energy electrical energy electromagnetic energy sound energy mechanical energy.

Which of the following is true of the physiological effects of cold? The shorter the cold exposure, the deeper the cooling.- The application of cold energy increases joint range of motion. The most common method of cold transfer is conduction. The length of cold exposure has the least influence on the extent to which a tissue cools.

The most common method of cold transfer is conduction. In cryotherapy, the most common method for cold transfer to tissue is through conduction. The extent to which tissue is cooled depends on the cold medium that is being applied, the length of cold exposure, and the conductivity of the area being cooled. In most cases, the longer the cold exposure, the deeper the cooling.

In the context of muscle contraction, what happens as the frequency of stimulation increases? The circulation of blood through the muscle decreases to cool the tissue. The muscle atrophies rapidly. The length of the muscle rapidly increases. The muscle develops tension until a tetanic contraction is achieved.

The muscle develops tension until a tetanic contraction is achieved. The quality of a muscle contraction changes according to the changes in current parameters. As the frequency of stimulation increases, the muscle develops more tension because of progressive shortening of the muscle, until a tetanic contraction is achieved.

Which of the following techniques can be used to relieve ischemia? Theromotherapy UV Light Therapy Microwave disthermy Ultrasound

Theromotherapy Muscle spasm caused by ischemia can be relieved by heat, which increases blood flow to the area of injury. Heat is also believed to assist the healing process by a number of mechanisms, such as raising temperature, increasing metabolism, reducing oxygen tension, lowering the pH level, increasing capillary permeability, and releasing histamine and bradykinin which cause vasodilation.

Identify a true statement about therapeutic modalities. They are widely used by trainers as well as therapists and chiropractors. The efficiency of therapeutic modalities has been clinically proven. Athletic trainers can always incorporate therapeutic modalities into clinical treatments. Healthcare professionals rely on scientific evidence-based data generated by researchers.

They are widely used by trainers as well as therapists and chiropractors.

____________ is a drawing tension applied to a body segment. Massage Traction Acupressure massage Intermittent compression

Traction Traction is a drawing tension applied to body segment. It is most commonly used in the cervical and lumbar regions of the spine

The therapeutic application of low-level lasers helps in ____________. Increasing microorganisms Decreasing vascularization Decelerating collagen synthesis Treating pain and inflammation

Treating pain and inflammation. The proposed therapeutic applications of lasers in physical medication include acceleration of collagen synthesis, decrease in microorganisms, increase in vascularization, and reduction of pain and inflammation.

True or false: Energy sources like chemical can be used for the process of conversion.

True Conversion refers to the generation of heat from another energy form, such as sound, electricity, and chemical agents.

True or false: after the first session of vapocoolant spraying and stretching, an athletic training should warm the muscle with a massage or a hot pack.

True Step 10: After the first session of spraying and stretching, warm the muscle with a hot pack or by vigorous massage.

One _____ is the amount of energy required to send currently one ampere through a resistance of one ohm

Volt

Three types of whirlpools:

Whirlpool therapy is a combination of massage and water immersion. The extremity tank, which is used for treating legs and arms; the lowboy tank, used for full-body immersion; and the highboy tank, which is designed for the hip or the leg.

Which of the following scenarios best describes the application of positional traction? After sustaining a spinal injury, Dave undergoes traction with the help of specialized equipment that tilts him upside down. After sustaining a spinal injury, Diana undergoes traction on a trial and error basis to determine her position of comfort. Steve sustains an injury in his neck and is recommended to undergo cervical traction with the help of a wall-mounted system. Lena undergoes cervical traction in the supine position. She is on a split table and her cervical harness under her chin.

after sustaining a spinal injury, Diana undergoes traction on a trial and error basis to determine her position of comfort. Positional traction is used on a trial-and-error basis to determine maximum position of comfort or to accomplish a specific treatment goal

____________ refers to the measure of the volume or amount of the current.

ampere The volume or amount of the current is measured in amperes (A); 1 A equals the rate of flow of 1 coulomb (C) per second. A coulomb is a unit of electrical charge and is defined as the quantity of an electrical charge that can be transferred by 1 A in 1 second.

After applying the vapocoolant spray on an injured area, an athletic trainer should __________. force stretch the muscle to initiate healing process apply an ice pack on the injured area overload the muscle with strenuous exercise begin firm stretching within the patient's pain tolerance.

begin firm stretching within the patient's pain tolerance.

Which of the following is the most popular vapocoolant? cold gel fluorimethane hydrogen fluoride ethyl chloride

fluorimethane The most popular vapocoolant is fluori-methane, a nonflammable, nontoxic substance. Under pressure in a bottle, it gives off a fine spray when it is inverted and an emitter is pressed.

After the immersion of a body part in cold- or ice-water, a patient proceeds through the ____ stages of cold response. four nine two seven

four The patient immerses the body part in the water and proceeds through the four stages of cold response. This process may take 10 to 15 minutes. Cold water immersion used in combination with electrical stimulation has been shown to minimize edema formation

The 3 neurophysiological mechanisms associated with pain modulation:

gate control - frequency should be set as high as possible to create as much sensory cutaneous stimulation as possible. descending pathway pain control - frequency should be 80 pulses per second. opiate pain control - frequency should be set at 1 to 5 pps.

One of the features of a hydrocollator pack is that it ____________. uses paraffin wax to apply heat. is devoid of any kind of limitations helps in the general relaxation and reduction of muscle spasm significantly heats even the deeper tissues such as the musculature

helps in the general relaxation and reduction of muscle spasm The major value hydrocollator pack is that its use results in general relaxation and reduction of the pain-spasm-ischemia-hypoxia-pain cycle. There are limitations of the hydrocollator pack in that the deeper tissues, including the musculature, are usually not significantly heated because the heat transfer from the skin surface into deeper tissues is inhibited by the subcutaneous fat, which acts as a thermal insulator, and by the increased blood flow to the skin, which cools and carries away the heat externally applied.

________ ___________ causes a slight temperature increase during cooling.

hunting response It has been hypothesized that when local temperature is lowered considerably for a period of about 30 minutes, intermittent periods of vasodilation occur, lasting 4 to 6 minutes. This phenomenon has come to be known as the hunting response and is said to be necessary to prevent local tissue injury caused by cold. The hunting response has been accepted for a number of years as fact; in reality, however, it actually refers to measured temperature changes rather than circulatory changes. Some clinicians have taken the liberty of inferring that temperature changes produce circulatory changes, and this is simply not what the hunting response is. The hunting response is more likely a measurement artifact than an actual change in blood flow in response to cold.

The desirable therapeutic effects of heat include:

increasing the extensibility of collagen tissues; decreasing joint stiffness; reducing pain; relieving muscle spasm; reducing inflammation, edema, and exudates in the postacute phase of healing; and increasing blood flow.

One of the features of a paraffin bath is that it ____________. uses a tank and a turbine motor is a popular method for applying heat to the distal extremities offers a linear procedure for treatment is most effective for treating open wounds

is a popular method for applying heat to the distal extremities Paraffin is a popular method for applying heat to the distal extremities. The commercial paraffin bath is a thermostatically controlled unit that maintains a temperature of 126°F to 130°F (52°C to 54°C). The paraffin mixture consists of a ratio of 25 kilograms of paraffin wax to 1 liter of mineral oil. Slats at the bottom of the container protect the patient from burns and collect the settling dirt. Also required for treatment are plastic bags, paper towels, and towels.

Which of the following is true of the ice massage technique? it can be applied only by a trained professional it has a thermotherapeutic modality it induces sensations of aching and numbness it is commonly used over tendons and the belly of a muscle

it induces sensations of aching and numbness it is commonly used over tendons and the belly of a muscle Ice massage is commonly used over tendons, the belly of a muscle, bursae, or myofascial trigger points. Ice massage is a cryotherapeutic method that is performed on a small body area. It can be applied by the athletic trainer or the patient. Grasping the ice cylinder, the athletic trainer rubs the ice over the patient's skin in overlapping circles in a 4- to 6-inch (10 to 15 cm) area for 5 to 10 minutes. The patient should experience the sensations of cold, burning, aching, and numbness. When analgesia has been reached, the patient can engage in stretching or exercise

Duration refers to the ___________. number of waveforms emitted by an electrical stimulating unit length of time that current is flowing ability of the electrical stimulating unit to change its magnitude voltage output of the stimulating unit.

length of time that current is flowing Duration refers to the length of time that current is flowing. It is also referred to as pulse width or pulse duration. Duration is preset on most of the high-voltage monophasic stimulators.